Healthcare Provider Details

I. General information

NPI: 1043732613
Provider Name (Legal Business Name): COLLEEN KELLEHER ZENCZAK-MAGILL AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN KELLEHER ZENCZAK AU.D.

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST FL 6
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

601 N CAROLINE ST FL 6
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6153
  • Fax: 443-287-6340
Mailing address:
  • Phone: 410-955-6153
  • Fax: 443-287-6340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01410
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: